Facility Evaluation Report

On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of completing an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by care giving staff. Administrator (AD) Fredric Robart was notified via telephone and arrived shortly after in order to assist with the annual inspection. LPA conducted a tour of the facility and observed the following. AD does not have a valid Administrator certificate a deficiency was issued on today's date.

The facility is a one storied home with six bedrooms two of which are utilized for two and four are utilized for residents in care. The facility is equipped with a detached two car garage. LPA observed the kitchen area to be clean and free of any mildew and debris. LPA observed the kitchen area to be equipped with a refrigerator, microwave, and gas stove. All appeared to be in good repair and tested operational. LPA observed the facility to have a two day supply of perishable food and a seven day supply of non-perishable food along with a sufficient amount of emergency water on hand.

LPA observed all resident rooms to be clean and free of any debris and hazards. LPA observed the resident bedrooms to be large enough to walk about freely. LPA observed all bedrooms to have all required furnishings including a chair, a lamp, a bed, clean linens in good repair; meaning no strains or tears, a chest of drawers, and enough storage space to store personal belongings. LPA observed all facility restrooms to be clean and free of any mildew and debris. LPA observed all restrooms to have all required furnishings such as grab bars, slip resistant floor matts, and a shower chair. LPA observed all water faucets and toilets to be in good repair and tested operational. Hot water temperature tested between 111.3 and 114.4 degrees Fahrenheit. CONTINUED ON LIC809-C